Contemporary strategies for cardio-respiratory monitoring in the perioperative period in abdominal and thoracic surgery: cytoprotective methods and predictors of complications

This review provides an analysis of contemporary strategies and methods for cardiopulmonary monitoring and cytoprotection used in the management of the perioperative period in patients undergoing abdominal and thoracic surgery. A key aspect is the shift from reactive correction of intraoperative complications to their proactive prediction and prevention, which helps to reduce the risks of postoperative complications. In the preoperative period, these methods are implemented through comprehensive risk stratification using validated clinical scales (RCDI, NSQIP), assessment of highly sensitive biomarkers (NT-proBNP, hs-cTn), and instrumental tests of the patient's functional reserves, supplemented by multimodal prehabilitation programs. The intraoperative period is characterized by a shift in focus from monitoring "pressure" to assessing "flow" using goal-directed hemodynamic therapy (GDFT) algorithms based on dynamic parameters, such as stroke volume variation and pulse pressure variation. A synergistic effect is achieved by combining GDFT with protective lung ventilation, which involves optimizing driving pressure and individualized PEEP titration to minimize ventilator-associated lung injury. A significant contribution is made by pharmacological cytoprotection, including cardioprotection with volatile anesthetics and statins, as well as pulmoprotection with corticosteroids. In the postoperative period, continuity of care is ensured by extending respiratory support with non-invasive ventilation (NIV), continued hemodynamic monitoring, and early mobilization using Enhanced Recovery After Surgery (ERAS) protocols. Together, these measures reduce the length of hospital stay and the incidence of complications. The implementation of a multidisciplinary approach that integrates predictive diagnostics, individualized monitoring, and multi-level cytoprotection at all stages of the perioperative period is establishing new standards of care aimed at improving postoperative outcomes in high-risk surgical patients.